Buprenorphine Implants and Opioid Dependence

Abstract

To the Editor: Dr Ling and colleagues provided evidence of the effectiveness of buprenorphine implants for the treatment of opioid dependence. However, as Dr O’Connor pointed out in his accompanying Editorial, there are barriers to this approach, and it remains to be seen whether this is more effective than the current practice of prescribing sublingual buprenorphine in an office-based setting. In their discussion, the study authors made a case for the superiority of implants over the current approach by selectively comparing their 6-month treatment retention of 65.7% with 3 other studies with rates ranging from 33% to 38%. However, none of these studies assessed office-based treatment. One (reference 21 in the article) provided a modest maximum dose of 8 mg per day of buprenorphine; another (reference 22) was a 16-week trial followed by a 10-week taper-off treatment; and the third (reference 20) was a study of a stepped-care approach that reported a 6-month treatment retention of 77%, but approximately half of those assigned to buprenorphine switched to methadone maintenance. In contrast, there are published studies of office-based sublingual buprenorphine treatment that report much better treatment retention rates. In the open-label phase of the landmark study by Fudala et al, 55% of the participants received at least 6 months of treatment. In an analysis of officebased buprenorphine treatment at the Johns Hopkins Bayview Medical Center, 57% of patients remained in treatment at 12 months.